Medicare’s front door, primary health care, needs a remodel

In discussing the sustainability of health care in Canada, we need to reframe the debate from speaking about costs to speaking about value.

There are many things we should and can change to get better value from the significant resources we dedicate to health care. But if I could cite just one change that would make health care more sustainable, it would be transforming the front door to the health-care system – primary health care. Albertans, for example, say once they have entered the health-care system they receive excellent care. Their problem is getting to and through that front door.

When we talk about health care, often the debate focuses on the latest and newest technologies, or on access to acute care services. These are important, of course. We must provide appropriate access to needed services when people are sick or injured, but more attention must be paid by policy-makers to that first contact, and the early intervention, co-ordination and ongoing support that might prevent the need for acute care.

People often seek care through emergency rooms simply because they don’t have anywhere else to go. Questions that could be answered by a nurse or pharmacist often wait weeks for a physician appointment. Patients often have to tell their story and basic information multiple times due to the lack of a shared electronic health record. Services are often not available outside of regular work hours, when it is convenient for patients and families. We need to do better. Complex health problems need a team of health professionals and that team needs to be brought together.

Reforming primary care requires purposeful action by governments and health system leaders. In Alberta, under the leadership of Premier Alison Redford, this includes building on our existing primary care networks and introducing a complementary team-based model called Family Care Clinics. These clinics will be one-stop portals to not only health but, eventually, other community services. Longer-term plans for Family Care Clinics include building linkages to early childhood development services, public health, education, continuing care, and mental health services, and to reach out to underserved populations.

Much of what we can do to transform primary care can be done through the reallocation of existing resources. So often in health care in this country, when we talk about innovation or improvement, we immediately jump to the conclusion that it’s a cost-plus exercise. This does not have to happen. Primary care reform is about making sure we’re not doing things in hospital that we can be doing in a community setting.

Sustainability and innovation in health care will only come about if we share our efforts across the country. Under the chairmanship of premiers Brad Wall and Robert Ghiz, I and other provincial health ministers are part of the Council of the Federation Health Care Working Group looking for co-operative ways to support health system sustainability. We are working to leverage our collective efforts as purchasers of health technologies and services, and also supporting more consistent application of evidence-based clinical guidelines across Canada. We are also sharing practices in team-based care. This co-operative work is well under way and holds great promise.

If I had to pick one thing that is central to the health system’s sustainability, it would be primary health care: providing patients and families a home in the health system. A home where there is a team that knows them, their families, and their community, intervenes early to prevent illness and, when illness occurs, assists in co-ordinating access to needed services.